While much is written about the structural characteristics of health care organizations, little is known about how or if these affect organizational processes. The intent of this research is: (1) to analyze decision making in health care organizations; and (2) to integrate theory about structure in health organizations with that of organizational and political decision making. The need for such research exists because most models of organizational decision making assume a structure that differs from that of health care organizations, and hence are of limited use to health care administrators. The characteristic combination of diverse goals and shared power suggests that decision making in these organizations will resemble that in political and community settings rather than other types of organizations. The basic questions to be addressed are: (1) what factors influence decision making; (2) do structural characteristics of health care organizations constrain which alternatives are available to the organization as the political model suggests; and (3) how can health care administrators manage the decision making process given the environment - and the consequent constraints - they operate within? These questions will be addressed through a study of budget cutting decisions in community health centers. How the interests and concerns of medical staff and Board members affect the administrators' choice of response will be of central concern. A comparative case method will be used, obtaining data from observation, documentation, and interview. Eight centers will be included in the sample.